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O~claration ot Domicll~ and ~itis~nship ~
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TO THE STATE ANO COUNTY TAX ASSESSOR, .
51. LUCIE COU~ITY, FLORIDA:
This is my declaratian of Oomicile and Citizenship in ths State of Florida that l am filinq this day in eooordanoe ar~d
~n conformity with Chapter 222, Secticn ?24.17, Florids StatutK.
1 was forme~ly a legal resident of Holland ~
Kiy) t5tah)
and 1 ~e:idad at _ B07c 7 NeM R1C11~ODd , Hovvevar 1 hsw thupsd my domkile
(StrMt and NumbK)
to and am and have been a bona fide resident of the State of Florida sinoe 4th day of
_~c ~ , 19 67 , and I reside at Gentile Roa~ -
- (Stroet and Number) {
FORT MERCE. SAINT LU~IE COUNTY, RORIQA
and this statement is to be taken as my declaration of citizenship, actval legal resicience and domidls in the Staro of Florida.
(Insert here a~ pe?tinent facts; such as sale cs; prc+perty or busineu, or relinquishment of employm~nt ~
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at former domicile, removal of family to new domicile, purchsse of home, etc.)
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Bntering Betty LUcille Bradford in the 2nd grade ~ ~
" Donnie inthe lst grade ~
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' Flt.EO AND RECOR~~~~ ,
ST.1.UC1E COUN'TY. F~-~?• ~
RECORD ~`~s~s~ t
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~sz oEC i e: so i
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~ i:OGER r 017R: S
CLERK CIRCU17 COURT
1 FURTHER G'ERTlFY that 1 will oomply with all other requiremenri of a I~pal resident of tfiis State.
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I FURTHER ~ERTIFY that i have no intention to retum to my forme~ domic,ile, and 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, fIORIDA, permanentiy. ~
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,~.J 1 ~~.~`J~j't. ~ ~a~~~ ' ;
`;;~•~'~1J~:~ \ {
. . - Bobbe~ Bradford, ( 1Mrs Charles ) ~
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- c (Address)
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'Swarn:~o.and'subsuibed before me this llth ~y of Decseber 19~7. ~
Rooae rom~?s
CIRCUR COURT Notary Public ~
gy ~Oc-~~-Gw D.C. My Commiuion e~cp'sros
(Te b~ ~oc~e~d in dvplicM~ and ai¢nal 8bd whh Clwk pra~il Covr~, and duplicah wilh Taoc As~eNO~J
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_ a~K169 ~147?.
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